Advanced Prescribing Pharmacist within Cardiology Multi-Disciplinary Team
Swansea Bay University Health Board
Introduction:
To address prescribing errors, medication inefficiencies, and discharge delays in cardiology, an advanced pharmacist prescriber was embedded into the Multi-Disciplinary Team (MDT) during ward weeks. This aimed to enhance prescribing safety, optimise therapy, and reduce drug spend.
Methods:
Using quality improvement methodology, the team applied tools such as process mapping, driver diagrams, and Plan-Do-Study-Act (PDSA) cycles. The prescribing pharmacist joined daily ward rounds, made real-time clinical decisions, and directly supported discharges. Stakeholder engagement included specialty boards, pharmacy leadership, and a business case submission to secure funding.
Outcomes:
The intervention significantly improved clinical safety and efficiency:
- Discharge prescribing errors dropped from 22% (doctors) to 1.4% (pharmacist).
- Time to resolve medication queries reduced from 7.48 hours to under 5 minutes.
- 3,584 new medications initiated, and 423 unnecessary medicines stopped.
- Discharge delays were effectively eliminated.
- Significant cost savings
- Improved patient flow, reduced overnight stays, and enhanced bed availability
- Deprescribing contributed to environmental sustainability by reducing medication waste.
Learnings:
Key lessons included the importance of early stakeholder engagement, clear baseline data, and embedding pharmacists directly into clinical teams to ensure trust and impact. Structured improvement tools helped track progress and adapt quickly. The project demonstrated how pharmacist-led care can align with both patient safety and decarbonisation goals.
What next?
The role is now permanently funded within cardiology, with plans to expand to other specialties like the Older Person Assessment Unit. A standardised implementation framework is in development to support wider adoption across NHS Wales. The project has sparked national interest and is contributing to a broader shift in how hospital pharmacy integrates into frontline multidisciplinary care.
